english.prescrire.org > Spotlight > Archives : 2011 > Type-2 diabetes: don’t aim for blood pressure that is unnecessarily low

Spotlight: Archives

Every month, the subjects in Prescrire’s Spotlight.

2011 : 1 | 30 | 60

Type-2 diabetes: don’t aim for blood pressure that is unnecessarily low

Aiming for a systolic blood pressure below 120 mm Hg, rather than 140 mm Hg, is of little benefit in preventing cardiovascular complications and exposes patients to the risk of serious adverse effects.

To reduce cardiovascular complications in patients with type-2 diabetes, trials have shown that drug treatment for arterial hypertension is warranted for blood pressure over 140/80 mm Hg.

In a clinical trial involving 4733 type-2 diabetes patients with a high cardiovascular risk, the patients were divided into an "intensive" group (aiming for a systolic blood pressure of < 120 mm Hg) and a "standard" group (aiming for < 140 mm Hg).

The intensive treatment had no impact either on the total mortality rate, the cardiovascular mortality rate, the incidence of non-fatal coronary disease, or that of cardiac failure. One stroke was averted per approximately 700 patients treated over 5 years.

Hyperkalaemia (excess potassium) and orthostatic hypotension occurred more frequently in patients under intensive treatment.

In short, the results of this trial showed that reducing systolic blood pressure to < 120 mm Hg rather than to < 140 mm Hg did not reduce mortality in type-2 diabetics with a high cardiovascular risk.

The modest reduction in the number of strokes was achieved at the cost of more frequent adverse effects.

©Prescrire 1 March 2011

"Type 2 diabetes: targeting blood pressure below 140/80 mmHg" Prescrire Int 2011; 20 (114): 77. (Pdf, subscribers only).

Download the full review